Provider Demographics
NPI:1881367977
Name:WILLIS, KATRINA (FNP-C)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:VALYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9522 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7724
Mailing Address - Country:US
Mailing Address - Phone:713-436-8151
Mailing Address - Fax:
Practice Address - Street 1:9522 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7724
Practice Address - Country:US
Practice Address - Phone:713-436-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily